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The bigger question is what is your relationship with the plastics person. My experience is that many are  resistant (for many reasons $$) to see ER patients. So, if it is  a minor procedure requiring only local anasthesia, AND the plastics person is  someone whom you'd like to come in in the future when needed (and does come in), I'd  accomodate him/her for the benefit of the patient. The patients appreciate not having to travel to their office for a procedure which can be  done in the ER. They came  to the ER for care in your ER!!
Gene Saltzberg MD






-----Original Message-----
From: Corboy, Jacqueline B <[log in to unmask]>
To: [log in to unmask]
Sent: Thu, Apr 1, 2010 1:35 pm
Subject: Re: Length of plastic surgery procedures in the ED


While some cases end up taking longer than one thinks, certainly anything that 
ou know going in will be markedly more than 30-45 minutes should NOT be 
erformed in the ED setting.  That is what surgi-suites, same day surgical units 
nd offices are for.  It is neither an appropriate use of an emergency 
epartment or its staff AND it may be unsafe for the patient, particularly if 
he case requires sedation for prolonged periods.  General anesthesia is a much 
etter way to go.  I'm surprised your hospital does not restrict his activities.  
'm assuming that these cases are ones coming initially through the ED that 
equire consultation and not his elective private patients - I've seen that in 
ome community EDs and it drives me crazy!
Jackie Corboy
hildrens Memorial Hospital
orthwest Community Hospital
________________________________________
rom: Pediatric Emergency Medicine Discussion List [[log in to unmask]] 
n Behalf Of Thomas Krzmarzick [[log in to unmask]]
ent: Thursday, April 01, 2010 7:53 AM
o: [log in to unmask]
ubject: Length of plastic surgery procedures in the ED
Recently, one of our plastic surgeons is repairing complex wounds in small
hildren in the ED rather than take them to the operating room.  Several of
hese cases have lasted 4 hours (one case was 6 hours).  He has been
esistant to having these patients sedated for their procedure.  I don't take
atients to the OR so I don't know everything that goes into the decision
aking process.  My gut tells me that a case that takes longer than 90
inutes or so needs to be done elsewhere (OR).  Besides the care issues,
ying up my PCA/nurse for hours (or ED MD if he would let us sedate these
atients) is detrimental to our patient flow.
I am trying to get a feel for what is done in other peds EDs.
Do you have a limit on the length of the case that can be done in the ED?
How do you handle these type of cases in your institution?
Thanks.
Thomas Krzmarzick M.D.
edical Director
ayton Childrens
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